■由于合并症和相关的安全风险,严重特应性皮炎(AD)在儿科和青少年患者中的治疗带来了重大挑战.
■研究儿童和青少年中重度特应性皮炎的全身治疗的有效性和安全性。
■2024年2月29日,在Embase进行了系统的文献检索,PubMed,和Cochrane中央受控试验登记册(中央)。未应用日期限制。随机临床试验,队列研究,大型案例系列,我们进行了meta分析,以评估儿童和青少年中重度特应性皮炎全身治疗的疗效(或有效性)和/或安全性.
■初步搜索产生了1457个结果,其中19篇独特文章共3741例患者被纳入分析.总的来说,每种全身药物的可用数据是有限的,纳入的常规全身治疗研究的总体质量相对较低。当Dupilumab用作独立治疗时,30%-40%的6个月至2岁的婴儿和幼儿达到EASI-75,而50%的2至6岁的患者达到EASI-75。在6至12岁的儿童中,33.0%-59.0%的特应性皮炎患者达到EASI-75,并且当与局部皮质类固醇(TCS)联合使用时,69.7%-74.6%实现EASI-75。长期数据显示,该年龄组的EASI-75发生率在75.0%至94.0%之间。对于12至18岁的青少年,40%-71%的患者在12至16周内达到EASI-75,到第52周,80.8%的患者达到EASI-75。阿布西替尼治疗导致68.5%-72.0%的患者达到EASI-75。奥马珠单抗治疗在第24周显示SCORAD评分的百分比变化为-12.4%。在甲氨蝶呤治疗组中,12周时SCORAD变化为-26.25%,环孢素A组SCORAD变化为-25.01%。用IVIG(静脉内免疫球蛋白)治疗的患者在第4周显示SCORAD百分比分数的-34.4%变化,其在第24周进一步下降47.12%。接受4mgBaricitinib和TCS的患者在16周时EASI-75的发生率为52.5%,接受不同剂量upadacitinib的患者在16周时EASI-75的发生率为63-75%.在接受各种剂量曲洛金单抗的患者中,16周时EASI-75的发生率约为28%。观察到的最常见的不良事件是鼻咽炎,呼吸事件和过敏性皮炎。
■了解不良事件和合并用药至关重要,和适当的剂量和频繁的实验室和临床监测也是必不可少的。更多现实世界的证据和前瞻性队列研究分析儿童和青少年全身治疗的有效性和安全性对于优化个性化,有效,以及该年龄组特应性皮炎患者不断增长的人群的安全管理。
UNASSIGNED: Due to comorbidities and associated safety risks, the management of severe atopic dermatitis (AD) in pediatric and adolescent patients poses significant challenges.
UNASSIGNED: To examine the efficacy and safety of systemic therapies for the treatment of moderate-to-severe atopic dermatitis in children and adolescents.
UNASSIGNED: On Feb 29, 2024, a systematic literature search was conducted in Embase, PubMed, and the Cochrane Central Register of Controlled Trials (Central). No date restrictions were applied. Randomized clinical trials, cohort studies, large case series, and meta-analyses were assessed to evaluate the efficacy (or effectiveness) and/or safety of systemic treatments for moderate-to-severe atopic dermatitis in children and adolescents.
UNASSIGNED: A preliminary search yielded 1457 results, from which 19 unique articles with a total of 3741 patients were included in the analysis. Overall, the available data for each systemic medication are limited, and the overall quality of the included studies on conventional systemic treatments is relatively low. When Dupilumab was used as a standalone treatment, 30%-40% of infants and toddlers aged 6 months to 2 years achieved EASI-75, while 50% of patients aged 2 to 6 years achieved EASI-75. In children aged 6 to 12 years, 33.0%-59.0% of atopic dermatitis patients achieved EASI-75, and when combined with topical corticosteroids (TCS), 69.7%-74.6% achieved EASI-75. Long-term data showed EASI-75 rates ranging from 75.0% to 94.0% for this age group. For adolescents aged 12 to 18 years, 40%-71% of patients achieved EASI-75 within 12 to 16 weeks, and by week 52, 80.8% of patients achieved EASI-75.Abrocitinib treatment resulted in 68.5%-72.0% of patients achieving EASI-75. Omalizumab treatment at week 24 showed a percentage change in SCORAD scores of -12.4%. In the Methotrexate treatment group, there was a SCORAD change of -26.25% at week 12, while the Cyclosporine A group had a SCORAD change of -25.01%. Patients treated with IVIG (Intravenous Immunoglobulin) showed a -34.4% change in SCORAD percentage scores at week 4, which further decreased by 47.12% at week 24. Patients receiving 4mg of Baricitinib and TCS had a 52.5% rate of EASI-75 at 16 weeks, and patients receiving different doses of upadacitinib had a 63-75% rate of EASI-75 at 16 weeks. The rate of EASI-75 at 16 weeks was around 28% in patients who received various doses of Tralokinumab.The most common adverse events observed were nasopharyngitis, respiratory events and dermatitis atopic.
UNASSIGNED: Awareness of adverse events and concomitant medications is crucial, and appropriate dosing and frequent laboratory and clinical monitoring are also essential. More real-world evidence and prospective cohort studies analyzing the effectiveness and safety of systemic therapies in children and adolescents are of paramount importance for optimizing personalized, effective, and safe management of the growing population of patients with atopic dermatitis in this age group.